Using healthy life years (HeaLYs) to assess programming needs in a public health unit.

In December 1997, public health units in Ontario received revised mandatory program guidelines from the Ministry of Health in advance of the downloading of public health to municipalities. Public health units face difficult decisions in allocating municipal resources to meet the Province's mandated programs. To set priorities for resource allocation, it is critical to assess need across program areas and to use a common unit in doing so. This paper applies the Healthy Life Years (HeaLYs) method in assessing health need related to the mandatory programs for the population of Wellington and Dufferin counties in Ontario. The HeaLYs method incorporates duration and severity of ill-health, incidence and mortality in calculating years of healthy life lost (YHLL). For Wellington-Dufferin, the leading causes of YHLL were concentrated in the program areas of chronic disease, injury, and substance abuse and included four areas not addressed in the MPG (suicide, depression, dementia, and osteoarthritis).

Trends and variations in perinatal mortality and low birthweight: the contribution of socio-economic factors.

OBJECTIVE: To examine trends and regional variations in perinatal mortality and low birthweight (LBW) and regional variations in socio-economic risk factors. METHODS: Population-based study of Central West Region of Ontario with approximately 28,000 births annually during the period 1988-1995 using vital statistics records and Census data. RESULTS AND CONCLUSIONS: There was no significant change in the perinatal mortality rate averaging 9.4 per 1,000 births per year. The LBW rate increased from 49.7 to 54.8 per 1,000, while the prematurity rate increased from 56.1 to 75.8 per 1,000. Significant variation occurred in outcomes among different regions, which was partially explained by socio-economic factors. The increases in LBW and prematurity rate emphasize the need for effective targeted services and programs. In their planning and implementation, regional variations in socio-economic factors, and other factors such as: the availability and utilization of services and barriers to access in services, require further evaluation and consideration.

The relationship between smoking and self-esteem.

Tobacco use is recognized as the most significant cause of preventable morbidity and mortality. In recent years health professionals have shifted emphasis from treating adult smokers to preventing smoking among children. This has prompted a number of studies of the determinants of smoking behavior among adolescents. Although some recent research has associated low self-esteem with smoking, other work challenges the relationship between self-esteem and health behavior. This study examines the relationship between adolescent self-esteem and smoking among a large cohort (N = 3,567) of adolescents who were surveyed between the 6th and 10th grades. Findings suggest that self-esteem may be a factor in the smoking behavior of female adolescents in grades 6-8, but not for males in any grade. This suggests that females may have different motivations to initiate and maintain the smoking habit.

Compliance for Kids: a community-based tobacco prevention project.

This article reports on the findings of a pre-test/post-test evaluation of the Compliance for Kids program carried out in three different communities. It demonstrates that it is indeed possible for a locally directed program to influence community standards of behaviour. It also suggests that in larger areas, such programs might better be implemented at the neighbourhood than at the city-wide level; and that merchants are influenced more by threat of enforcement than knowledge of laws. Such findings reinforce the need both for continued community programming and comprehensive legislation and enforcement.

Calgary's needle exchange program: profile of injection drug users.

This report provides a baseline description of a sample of injection drug users who are clients of a needle exchange program in Calgary, Alberta. The results of the study suggest a relatively older, predominantly male clientele who reported heavy and sustained use of drugs, particularly cocaine. Despite a high level of awareness of the basic modes of HIV transmission, many respondents still engaged in high risk injection practices and/or sexual practices. In addition, self-perception of risk was much lower than reported behaviour would indicate. Three percent of the sample were HIV+ at the time of the interview. In addition to providing a baseline for further evaluation, the results of this study can be used by program planners to target interventions more effectively.

Predicting cigarette smoking among adolescents using cross-sectional and longitudinal approaches.

The ability to identify groups of children at risk of initiating a smoking habit may prove useful in developing effective smoking prevention programs. This report includes data collected over a three-year period, and attempts to predict adolescents' smoking behavior using both cross-sectional and longitudinal analyses. In addition, predictor variables reflecting both interpersonal and intrapersonal domains were included. Results indicated the highest rates of accurate classification into smoking categories were achieved with cross-sectional analyses. In addition, interpersonal variables emerged as most important in all analyses. Implications for smoking prevention programming are discussed.

Preventing cigarette smoking among children: results of a four-year evaluation of the PAL program.

The issue of prevention of tobacco use has received a great deal of attention in recent years. As an outgrowth of this interest, several smoking prevention programs based on a social influence approach have been developed. One example of these types of programs is the Peer Assisted Learning (PAL) prevention program which was produced by Health and Welfare Canada. We discuss the preliminary results of a prospective cohort evaluation of the PAL program. This evaluation suggests that the program has some utility in preventing the uptake of tobacco use among young males; however, its efficacy with females has been negligible. It is clear that prevention programming will have to consider targeting males and females in different ways.

The prevalence of smokeless tobacco and cigarette use among sixth, seventh and eighth grade students: a longitudinal investigation.

Few studies have reported on the prevalence of smokeless tobacco use among young children in Canada, although research conducted in the United States indicates a rising trend in smokeless tobacco use among school-aged children. We report on rates of smokeless tobacco experimentation and current use and its relationship to cigarette smoking in a large sample of students followed from Grade 6 through Grade 8 in Calgary, Canada. The rates of smokeless tobacco experimentation and use reported are low in comparison to the corresponding prevalence reported in the American findings. In accordance with the American findings, however, both experimentation and current use of smokeless tobacco were more prevalent among males. Also, a high correspondence between smokeless tobacco and cigarette use was observed.

A three-year census of dependent elderly.

One attempt to limit the rising health care cost for the expanding elderly population has been to control institutional utilization through community care programs. Evaluative research in this field has focussed on comparing community programs to institutionalization, rather than a simpler and more relevant examination of prevailing patterns of care. This latter approach is important for several reasons: it allows one to examine the effects of new programs; to predict future service needs; to evaluate effectiveness and appropriateness of current patterns of care; and it provides the basis for a co-ordinated approach to planning and policy. For the past three years, all institutions and community agencies in Calgary that provide care to the elderly have co-operated in an annual census to determine the location and services received by each person over 65. Study findings suggest directions for future policy and planning, and raise questions for future research.

Planned and unplanned home births and hospital births in Calgary, Alberta, 1984-87.

Information collected on all home births in Calgary (Canada) between the years 1984 and 1987, was examined and analyzed according to whether the home birth environment had been planned or unplanned. The two groups were compared to each other and to all hospital births according to demographic characteristics of mothers, indicators of prenatal care, and birth outcome. Mothers who had planned their home birth were more likely to be primiparous, attend prenatal classes, obtain regular prenatal care from a physician, and have babies with a higher birth weight than either the unplanned or hospital group. Of particular concern, however, were the subset of unplanned home births who were primiparous. These mothers attended prenatal classes less frequently than any other group, reported the lowest number of physician visits, were youngest, and least likely to be married. In addition their babies averaged the shortest gestational age and the lowest birth weight. Findings in general show that planned and unplanned home births must be considered as heterogeneous groups in any comparison of risk factors and of birth outcome between home and hospital births. Further, within the unplanned group, multiparous women differ from primiparous women. Given the limitations inherent in this and similar studies, the apparent better outcome in the planned home birth group, as measured by birth weight, must be viewed with caution.